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Management of melanoma metastases in the brain
Affiliations- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute – Oncology Center, Warsaw, Poland
- Department of Head & Neck Cancer, Maria Skłodowska-Curie Institute – Oncology Center, Warsaw, Poland
- Department of Oncology and Radiotherapy, Maria Skłodowska-Curie Institute – Oncology Center, Warsaw, Poland
- Department of Central Nervous System Tumours, Maria Skłodowska-Curie Institute – Oncology Center, Warsaw, Poland
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Abstract
The basic principle for the diagnosis of melanoma metastases in the brain should be the management of multidisciplinary teams including at least a neurosurgeon, radiotherapist and clinical oncologist experienced in the treatment of melanoma and melanoma metastases in the CNS. Detection of brain lesions is associated with poor prognosis; metastases in the brain are the cause of death in 20–50% patients, and symptomatic tumours are a direct cause of death in about 90% patients. Treatment of melanoma with CNS metastases may include local management and/or systemic and symptomatic treatment. In the last 5 years, 10 new advanced melanoma drugs have been registered in Europe. Two-drug therapy anti-PD-1 and anti-CTLA-4 (nivolumab with ipilimumab) is the treatment of choice for asymptomatic melanoma metastases in the brain, while in the presence of BRAF mutations and asymptomatic metastases systemic treatment with BRAFi and MEKi may be the first-choice treatment.
Abstract
The basic principle for the diagnosis of melanoma metastases in the brain should be the management of multidisciplinary teams including at least a neurosurgeon, radiotherapist and clinical oncologist experienced in the treatment of melanoma and melanoma metastases in the CNS. Detection of brain lesions is associated with poor prognosis; metastases in the brain are the cause of death in 20–50% patients, and symptomatic tumours are a direct cause of death in about 90% patients. Treatment of melanoma with CNS metastases may include local management and/or systemic and symptomatic treatment. In the last 5 years, 10 new advanced melanoma drugs have been registered in Europe. Two-drug therapy anti-PD-1 and anti-CTLA-4 (nivolumab with ipilimumab) is the treatment of choice for asymptomatic melanoma metastases in the brain, while in the presence of BRAF mutations and asymptomatic metastases systemic treatment with BRAFi and MEKi may be the first-choice treatment.
Keywords
melanoma; brain; metastases; radiotherapy; immunotherapy; BRAF inhibitors; MEK inhibitors
About this articleTitle
Management of melanoma metastases in the brain
Journal
Nowotwory. Journal of Oncology
Issue
Article type
Review paper
Pages
86-96
Published online
2019-10-31
Page views
656
Article views/downloads
706
DOI
Bibliographic record
Nowotwory. Journal of Oncology 2019;69(3-4):86-96.
Keywords
melanoma
brain
metastases
radiotherapy
immunotherapy
BRAF inhibitors
MEK inhibitors
Authors
Piotr Rutkowski
Dorota Kiprian
Monika Dudzisz-Śledź
Tomasz Świtaj
Radosław Michalik
Mateusz Spałek
Katarzyna Kozak
Tomasz Mandat